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De Luca G.,University of Piemonte Orientale | Verdoia M.,University of Piemonte Orientale | Dirksen M.T.,Onze Lieve Vrouwe Gasthuis | Spaulding C.,French Institute of Health and Medical Research | And 16 more authors.
Atherosclerosis | Year: 2013

Background: Several studies have found that among patients with ST-segment elevation myocardial infarction (STEMI) treated by thrombolysis, female sex is associated with a worse outcome. However, still controversial is the prognostic impact of gender in primary angioplasty, especially in the era of drug-eluting stents (DES). Therefore, the aim of this study was to investigate sex-related differences in clinical outcome in patients with STEMI treated with primary angioplasty with Bare-Metal Stent (BMS) orDES. Methods: Our population is represented by 6298 STEMI patients undergoing primary angioplasty and stent implantation included in the DESERT database. Follow-up data were collected from 3 to 6 years after primary angioplasty. Results: Female gender was observed in 1466 (23.2%) out of 6298 STEMI patients. Women were older (65.3±12.4 vs 59.3±11.4 years, p<0.001), with higher prevalence of diabetes (18.6% vs 14.5%, p<0.001), hypertension (52.4% vs 41.4%, p<0.001), slightly longer ischemia time (272±247 vs 258±220min, p=0.06). No difference was observed in terms of angiographic and procedural characteristics.Follow-up data were available at a mean of 1201±441 days. At long-term follow-up female gender was associated with a significantly higher rate of death (11.7% vs 8.5%, HR [95% CI]=1.45 [1.18-1.78], p<0.001), while no difference was observed in terms of reinfarction (HR [95% CI]=1.14 [0.89-1.45], p=0.3), ST (HR [95% CI]=1.12 [0.85-1.48], p=0.4), with similar temporal distribution (acute, subacute, late and very late) between male and female patients, and no difference in TVR (HR [95% CI]=1.11 [0.95-1.3], p=0.2, p=0.2). These results were confirmed in both patients receiving BMS or DES. The impact of female gender on mortality disappeared after correction for baseline confounding factors (HR [95% CI]=0.88 [0.71-1.09], p=0.25). Conclusions: This study shows that in patients with STEMI treated by primary angioplasty, female gender is associated with higher mortality rate in comparison with men, and this is mainly due to their higher clinical and angiographic risk profiles. In fact, female sex did not emerge as an independent predictor of mortality. © 2013 Elsevier Ireland Ltd. Source

Wang L.,Worcester Polytechnic Institute | Zheng J.,Washington University in St. Louis | Maehara A.,The Cardiovascular Research Foundation | Yang C.,Worcester Polytechnic Institute | And 8 more authors.
PLoS Computational Biology | Year: 2015

Plaque vulnerability, defined as the likelihood that a plaque would rupture, is difficult to quantify due to lack of in vivo plaque rupture data. Morphological and stress-based plaque vulnerability indices were introduced as alternatives to obtain quantitative vulnerability assessment. Correlations between these indices and key plaque features were investigated. In vivo intravascular ultrasound (IVUS) data were acquired from 14 patients and IVUS-based 3D fluid-structure interaction (FSI) coronary plaque models with cyclic bending were constructed to obtain plaque wall stress/strain and flow shear stress for analysis. For the 617 slices from the 14 patients, lipid percentage, min cap thickness, critical plaque wall stress (CPWS), strain (CPWSn) and flow shear stress (CFSS) were recorded, and cap index, lipid index and morphological index were assigned to each slice using methods consistent with American Heart Association (AHA) plaque classification schemes. A stress index was introduced based on CPWS. Linear Mixed-Effects (LME) models were used to analyze the correlations between the mechanical and morphological indices and key morphological factors associated with plaque rupture. Our results indicated that for all 617 slices, CPWS correlated with min cap thickness, cap index, morphological index with r = -0.6414, 0.7852, and 0.7411 respectively (p<0.0001). The correlation between CPWS and lipid percentage, lipid index were weaker (r = 0.2445, r = 0.2338, p<0.0001). Stress index correlated with cap index, lipid index, morphological index positively with r = 0.8185, 0.3067, and 0.7715, respectively, all with p<0.0001. For all 617 slices, the stress index has 66.77% agreement with morphological index. Morphological and stress indices may serve as quantitative plaque vulnerability assessment supported by their strong correlations with morphological features associated with plaque rupture. Differences between the two indices may lead to better plaque assessment schemes when both indices were jointly used with further validations from clinical studies. © 2015 Wang et al. Source

Tang D.,Nanjing Southeast University | Tang D.,Worcester Polytechnic Institute | Kamm R.D.,Massachusetts Institute of Technology | Yang C.,Worcester Polytechnic Institute | And 11 more authors.
Journal of Biomechanics | Year: 2014

Medical imaging and image-based modeling have made considerable progress in recent years in identifying atherosclerotic plaque morphological and mechanical risk factors which may be used in developing improved patient screening strategies. However, a clear understanding is needed about what we have achieved and what is really needed to translate research to actual clinical practices and bring benefits to public health. Lack of in vivo data and clinical events to serve as gold standard to validate model predictions is a severe limitation. While this perspective paper provides a review of the key steps and findings of our group in image-based models for human carotid and coronary plaques and a limited review of related work by other groups, we also focus on grand challenges and uncertainties facing the researchers in the field to develop more accurate and predictive patient screening tools. © 2014 Elsevier Ltd. Source

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